Acute Disseminated Talaromyces marneffei in An Immunocompetent Patient

Wang, Pingli; Youfei, Chen; Xu, Hao; Ding, Liren; Wu, Zhiwei; Xu, Zhijiang; Wang, Kai

doi:10.1007/s11046-017-0127-7

Cited by 15 publications

(11 citation statements)

References 12 publications

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“…However, severe nephrotoxicity limits the clinical use of amphotericin B. As a broad-spectrum antifungal agent, voriconazole was reported to be effective for talaromycosis (13,14). Therefore, we chose voriconazole to treat this patient since it is safe, strong and within his economic affordability.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Talaromycosis of an Immunocompetent Patient

2021

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Background: Talaromycosis is a serious fungal infection which is rare in immunocompetent people. Since its clinical manifestations lack specificity, it is easy to escape diagnosis or be misdiagnosed leading to high mortality and poor prognosis. It is necessary to be alert to the disease when broad-spectrum antibiotics do not work well in immunocompetent patients.Case Presentation: A 79-year-old man was admitted to our Infectious Diseases Department for recurrent fever and cough. Before admission he has been treated with piperacillin-tazobactam, moxifloxacin followed by antituberculous agents in other hospitals while his symptoms were not thoroughly eased. During the first hospitalization in another hospital, he has been ordered a series of examination including radionuclide whole body bone imaging, transbronchial needle aspiration for subcarinal nodes. However, the results were negative showing no neoplasm. After being admitted to our hospital, he underwent various routine examinations. The initial diagnosis was bacterial pneumonia, and he was given meropenem injection and tigecycline injection successively, but there were no improvement of symptoms and inflammatory indicators. In the end, the main pathogen Talaromyces marneffei was confirmed using Metagenomic Next-Generation Sequencing (mNGS), and his clinical symptoms gradually relieved after targeted antifungal treatment using voriconazole.Conclusion: When empirical anti-infective treatment is ineffective, it is necessary to consider the possibility of opportunistic fungal infections on immunocompetent patients. mNGS, as a new generation of pathogenic testing methods, can often detect pathogenic bacteria faster than traditional methods, providing important help for clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Talaromycosis of an Immunocompetent Patient

2021

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“…marneffei infection is incrementally reported in both immunocompromised and immunosuppressed patients. In recent years, it has been observed even in immunocompetent patients [8]. Annually, about 50,000 acquired immunodeficiency syndrome (AIDS) patients are newly infected by T. marneffei, resulting in approximately 10% mortality in Southeast Asia [9].…”

Section: Discussionmentioning

confidence: 99%

Dermatoscopy for the rapid diagnosis of Talaromyces marneffei infection: a case report

Jian

Huang

et al. 2019

BMC Infect Dis

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Background: Talaromyces marneffei is a thermally dimorphic fungus endemic in southeast Asia. It predominantly occurs in both immunocompromised and immunosuppressed patients and can be fatal if diagnosis and treatment are delayed. The clinical manifestations of T. marneffei infection are nonspecific and rapid diagnosis of T. marneffei infection remains challenging. Case presentation: A 24-year-old man came to our outpatient department with the sign of common skin lesions. The lesions were cuticolor follicular papules with or without central umbilication, nodules and acne-like lesions, which are common in syringoma, steatocystoma multiplex and trichoepithelioma. A dermatoscopy examination was performed to differentiate these skin lesions. The dermatoscopic images revealed circular or quasi-circular whitish amorphous structure with a central brownish keratin plug, providing the diagnostic clues of T. marneffei infection. Therefore, a skin scrapings culture, skin biopsy and serological detection for human immunodeficiency virus (HIV) were performed. The final diagnosis of this patient was T. marneffei and HIV co-infection. Conclusion: Rapid diagnosis of T. marneffei infection is clinically challenging since presenting clinical manifestations are nonspecific with significant overlap with other common conditions. This case highlights that dermatoscopy is a promising tool for the rapid diagnosis of T. marneffei infection in patients with nonspecific skin lesions, assisting clinicians to avoid delayed diagnosis or misdiagnosis.

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“…Infection with T. marneffei was uncommonly reported prior to the AIDS epidemic, but has been subsequently described in several large series of cases from Thailand and Viet Nam [53,54,55,56]. Other forms of immunosuppression, including that associated with TNF-alpha inhibitor therapy, other biological immunotherapy, and organ transplantation, also predispose patients to disseminated talaromycosis [57,58]; much less commonly, immunocompetent persons may develop disseminated infection [59,60].…”

Section: Talaromycosis (Table 3)mentioning

confidence: 99%

“…In reviews of disseminated talaromycosis among patients with and without HIV/AIDS and in one paper focused on CNS disease among HIV/AIDS patients, no patients with CNS talaromycosis were described [54,56,61]. Several individual cases of CNS infection, including one in an immunocompetent patient, have been reported [58,59], but the most well-defined series of cases of CNS infection with T. marneffei is in HIV/AIDS patients from Viet Nam [53]. Of 677 cases of talaromycosis in patients with HIV/AIDS, 21 (3%) had CNS involvement.…”

Section: Talaromycosis (Table 3)mentioning

confidence: 99%

Central Nervous System Infection with Other Endemic Mycoses: Rare Manifestation of Blastomycosis, Paracoccidioidomycosis, Talaromycosis, and Sporotrichosis

Kauffman

2019

JoF

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The central nervous system (CNS) is not a major organ involved with infections caused by the endemic mycoses, with the possible exception of meningitis caused by Coccidioides species. When CNS infection does occur, the manifestations vary among the different endemic mycoses; mass-like lesions or diffuse meningeal involvement can occur, and isolated chronic meningitis, as well as widely disseminated acute infection that includes the CNS, are described. This review includes CNS infection caused by Blastomyces dermatitidis, Paracoccidioides brasiliensis, Talaromyces marneffei, and the Sporothrix species complex. The latter is not geographically restricted, in contrast to the classic endemic mycoses, but it is similar in that it is a dimorphic fungus. CNS infection with B. dermatitidis can present as isolated chronic meningitis or a space-occupying lesion usually in immunocompetent hosts, or as one manifestation of widespread disseminated infection in patients who are immunosuppressed. P. brasiliensis more frequently causes mass-like intracerebral lesions than meningitis, and most often CNS disease is part of disseminated infection found primarily in older patients with the chronic form of paracoccidioidomycosis. T. marneffei is the least likely of the endemic mycoses to cause CNS infection. Almost all reported cases have been in patients with advanced HIV infection and almost all have had widespread disseminated infection. Sporotrichosis is known to cause isolated chronic meningitis, primarily in immunocompetent individuals who do not have Sporothrix involvement of other organs. In contrast, CNS infection in patients with advanced HIV infection occurs as part of widespread disseminated infection.

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Acute Disseminated Talaromyces marneffei in An Immunocompetent Patient

Cited by 15 publications

References 12 publications

Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Talaromycosis of an Immunocompetent Patient

Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Talaromycosis of an Immunocompetent Patient

Dermatoscopy for the rapid diagnosis of Talaromyces marneffei infection: a case report

Central Nervous System Infection with Other Endemic Mycoses: Rare Manifestation of Blastomycosis, Paracoccidioidomycosis, Talaromycosis, and Sporotrichosis

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